Annual Report 2014 - REACH OUT MBUYA

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Annual Report 2014

Carnations

Place mats on table

Jewellery

Decorative hand made Floor carpets

Table set

Baby socks

Hand made door & bedside mats

Table & place mats

Toilet paper holder

Toilet/bathroom bin cover

Cistern cover

Ladies Hats

Bags

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Reach Out Mbuya Annual Report 2014

Vision A community free of the spread of HIV where those persons already infected and affected by HIV and AIDS are living positively with an improved quality of life.

Mission To curb the further spread of HIV infection among the less privileged members of society and enable those already living with HIV and AIDS to live a responsible and dignified life. We do this by focusing on educating individuals and the community about HIV and AIDS as well as providing holistic care to those already infected and their families.

Our Core Values •

Teamwork

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Client focus

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Professionalism

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Learning and growing organisation

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Solidarity

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Encouraging the direct involvement of persons living with HIV

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Respect for human life and enhancing human capacity

“Thank you so much for all the work you have done. You have touched many lives and warmed all of our hearts. I wish you all the very best-I am sure that you will overcome any and every one of the challenges you may face.’’ Dr. Jonathan Mermin, former CDC country director, 25th June 2014.

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Table of Contents Our Vision................................................................................................................................................................3 Our Mission..............................................................................................................................................................3 Our Core values.......................................................................................................................................................3 Acronyms..................................................................................................................................................................5 Executive summary..................................................................................................................................................9 Highlights of program activities..........................................................................................................................11 MEDICAL DIRECTORATE....................................................................................................................12

HIV PREVENTION...........................................................................................................................................12 HIV Counseling and Testing (HCT)..................................................................................................................12 HIV Prevention messaging..................................................................................................................................14 Elimination of Mother to child transmission of HIV.....................................................................................15 Clinical care and support services.......................................................................................................................17 Linkage into Care...................................................................................................................................................17 Positive Health, Dignity and prevention (PHDP)............................................................................................18 Maternal and Child Health (MCH) services......................................................................................................20 Nutrition support..................................................................................................................................................20 Anti-retroviral therapy (ART)..............................................................................................................................20 TB/HIV...................................................................................................................................................................21 Laboratory..............................................................................................................................................................22 Pharmacy management services..........................................................................................................................22 Outpatient and inpatient care at ROK...............................................................................................................23 COMMUNITY SUPPORT DEPARTMENT...........................................................................................26

Community Network of care (CNC).................................................................................................................26 Village saving and Loans Associations (VSLA)................................................................................................27 Roses of Mbuya.....................................................................................................................................................27 Orphans and Vulnerable Children (OVC).........................................................................................................29 Grandmothers’ project in Kasaala......................................................................................................................33 Barclays Bank sponsored training.......................................................................................................................34 Monitoring and Evaluation department........................................................................35 MEDIA RELATIONS...............................................................................................................................36 Governance, Management and staffing...........................................................................38

The Human Resources..........................................................................................................................................38 Staff promotions...................................................................................................................................................38 Appendices.................................................................................................................................43

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Reach Out Mbuya Annual Report 2014

Acronyms Acronyms AIDS ART ARV ANC BCP CATTS CDC DNA-PCR EPTB HBHCT HIV IDI KP M2M MCH MDR MOH OVC PACE PHC eMTCT PTB PPP ROK ROM UGANET VHT VSLA WHO

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Acquired Immune Deficiency Syndrome Anti-Retroviral Therapy Anti-Retroviral Antenatal care Basic Care Package Community ART and TB Treatment Supporters Centers for Diseases Control and Prevention Deoxyribonucleic Acid-Polymerase Chain Reaction Extra-Pulmonary Tuberculosis Home Based HIV Counseling and Testing Human Immunodeficiency Virus Infectious Diseases Institute Key populations Mother to Mother Maternal and Child Health Multi-Drug Resistant Ministry of Health Orphans and Vulnerable Children Program for Accessible Health Communication and Education Primary Health Care Elimination of Mother To Child Transmission of HIV Pulmonary Tuberculosis Public Private Partnership Reach Out Mbuya Parish HIV/AIDS Initiative – Kasaala site Reach Out Mbuya Parish HIV AIDS Initiative Uganda Network on Law, Ethics and HIV/AIDS Village Health Teams Village Savings and Loans Associations World Health Organization

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Foreword This year, we reached out to over 700 grandmothers who have borne the burden of HIV as caregivers and sometimes as clients as well. Their joy when they felt stronger after receiving free health care and support was a very humbling experience.

N

ine months ago, I took a bold step and walked into the unknown. All I knew was that it was a community of people that loved to serve their community and that was what drew me in. It has been a busy and exciting nine months of learning, growing, testing, celebrating and loving. Reach Out Mbuya (ROM) is not only an organization; it is a family where the patients, staff and management are one body with the same goal. I am thankful to all our partners; donors, friends and collaborators who have supported me and helped me feel welcome into this wonderful family. I therefore take this opportunity to share the activities and achievements from this wonderful family as you read the ROM 2014 annual report. This report is a true demonstration of the commitment and dedication of our staff and volunteers. This year, we focused on reaching out to the Key Populations, in particular; the sex workers, fisher folks and truckers. We stepped out of our comfort zone, reached out and dialogued with them. We have opened up our boundaries to reach out to our neighborhood that urgently needs our services too, while continuing to provide a holistic approach of care to the HIV infected in our community, keeping in mind that the family and community are key for a healthy individual. 6

Reach Out Mbuya Annual Report 2014

However, we were saddened by the loss of our dear founder and friend, Rev. Fr. Joseph Pietro Archetti and a former chairman Board of Directors (BOD), Rev. Fr. Mario Imperial. The dream and vision of Fr. Archetti lives on through all of us and we pray that when we meet him again, he will be able to say, “Well done good and faithful servant”. The family was yet hit again when many of clients lost their homes during the city evictions and we continue to stand with them as many of them still try to find a place they can call home. We are indebted to the invaluable support of our donors, BOD, partners and friends, many of whom have stood with us for over 10 years. Our priority for the coming year 2015 is to continue expanding our reach to the neighborhood, reaching out to more vulnerable and Key populations that have not been reached and strengthening our prevention work with the youth. It is also the year that we shall review the last 5 years of our strategic plan and develop a new plan to drive ROM for another five years. I thank the clients for the continued love and trust that they have shown in our work and programs and we pledge to continue providing you the best that we can as we move on to a new year filled with hope for the future. Hope you will find the report enriching. Dr. Betty Nsangi Kintu Executive Director

Message from the Chairman Board of Directors I am very grateful to all our donors and partners who have helped us reach to almost all the age groups. I am deeply impressed with the current ongoing projects; the grandmothers’ project in Kasaala where the parish priest testifies a reduction in requiem masses after “the grandmothers’ clinic” was initiated, the theatre that was opened still in Kasaala to reduce maternal mortality, youth who have been made useful citizens through crafts trainings and lastly the core, medical care. All this, to try and serve our clients in totality.

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014 has been a year with many rewarding moments, as well as some challenges. The year was marked by changes in management; with some board members term of service expiring and new ones voted during the Annual General Meeting, the Executive Director exiting and another welcomed and the death of my predecessors Reverend Fathers Mario Imperial and Joseph Archetti in May and July respectively that was disturbing-May their souls rest in Eternal Peace. I, the Directors and the Parishioners are very grateful for their long and honorable service to this community. I am humbled and honored to continue the work they started especially as we tackle one of the world’s greatest health challenges of our time.

We have done a lot over the years but yet admit to still have a lot to do as long as HIV/AIDS still exists. Collective action and greater involvement of People Living with HIV has proved helpful. Let us continue to work hard, to positively contribute to the elimination of HIV in our society. The responsibility is heavy, but let us shoulder it to have healthier generations in the future. We have a moral obligation to reach out to the most needy in our society. God Bless you all

Fr. John Mungereza Mccj Chairman Board of Directors

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Reach Out Mbuya HIV/AIDS (ROM) coverage ROM works with the ruralurban poor communities within Nakawa division in Kampala district, Bweyogerere parish in Wakiso district and Kasaala in Luweero district. With approximately 349,000 people in Nakawa, 2,740,000 in Wakiso district and 483,000 in Luweero. ROM operates in four static clinic sites of Mbuya, Kinawataka, Banda and Kasaala in Luweero

district. At Kasaala, HIV/ AIDS services are integrated into primary health care (PHC) services. Through the mobile outreaches, ROM brings comprehensive HIV/AIDS services closer to the people and in particular, to the Key populations. These outreaches include; Port bell landing sites, Kiwatule, Bweyogerere, Naguru go down and Mabuye

Port bell-landing site

St. Mbaga Tuzinde Catholic Church Kiwatule

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St. Charles Lwanga Namataba

Reach Out Mbuya (Administrative)

St. Jude Catholic Church Naguru

Reach Out Mbuya Annual Report 2014

in Kasaala. In addition, ROM works in partnership with public and private clinics (PPP) to offer HIV/AIDS services. The clinics involved in the PPP include; Bugolobi Medical center, Pedok domiciliary, Kitintale family clinic, Kamuli general clinic, Kirinya HC II, Kireka HC II, Good Samaritan maternity home, and Butumutumula HC II.

Kireka Rehabilitation Center

Kinawataka Knowledge Room

Our Lady of Consolanta Bweyogere Catholic Church

Executive summary This report covers activities performed during the period January 1 to December 31, 2014 in partnership with The Catholic Church, Ministry of Health, Uganda Catholic Medical Bureau, and with support from; PEPFAR through Centers for Diseases Control and Prevention (CDC), Medical Mission International, Reach Out Student Education fund (ROSE) in California, Sid’Ecole, Stephen Lewis Foundation (SLF), Barclays Bank, Centenary Bank, Housing Finance Bank, Quality Supermarket, and several individuals of good will without whom ROM would not have been able to produce the following results. ROM registered significant success towards improving the quality of service delivery to clients and their families. Training and mentorship of staff were implemented simultaneously with the provision of essential logistics and supplies, provision of the laboratory services, assessment of performance and learning from the best practice experiences. Special attention was given to the Key populations (KP) including; the fishing communities, commercial sex workers and long distance truck drivers who received comprehensive HIV care and prevention services.

In 2014, a total of 23,945 individuals received HCT, 3.4% increment as compared to the previous years. 1,915/23,945 (8.0%) individuals had a positive result. Overall 1,474 people living with HIV/AIDS (PLHIV) were newly enrolled into care. By December 2014, 6,726 of clients had been served with 6,203 still active in care (437 children below 15 years of age). 1,176 clients (13.2% children) were initiated on anti-retroviral therapy (ART) making 6,045/6203 (97.5%) of the patients’ active on ART, 7.2% of whom were children. Of the 1,429 pregnant and lactating mothers tested, 289 (9%) were HIV positive. 220 clients were newly diagnosed with active TB and were started on anti-TB treatment giving a total of 158 (31 were HIV negative) clients active on TB treatment by the end of the reporting period with TB treatment success rate of 87%. A total of 1,599 most-at-risk populations (MARPs) and 19,994 general population individuals were reached with HIV prevention services. Though several achievements were registered during the year, implementation was negatively impacted by major evictions of clients due to urban development.

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Former OVC shares his story Never let Circumstances Shape Your Future sales man for simcards and while working one day, he received a call from his mother that he had been enrolled under the school fees program of Reach Out Mbuya. “I am a bright guy. I was enrolled straight away in senior four at Kireka High School” Edward boasts “but I also read hard and came out with 38 aggregates in 8 subjects”. This may not seem good with the current trend of performance but for someone who had missed school for two straight years, he is right to boast.

Edward Nangigaye Production Manager, Ntake Bakery One of the criteria of being sponsored in School by Reach Out Mbuya (ROM) is that a child must either be infected or affected by HIV and despite meeting the two, another thorough household assessment is carried out. Edward Nangigaye whose mother, the late Margret Nalwadda was a client of ROM would have gone through the assessment on several occasions but did not. Not because he was not eligible but the need was and is always greater than the available resources, and “there were children worse than Edward at the time”, says a social worker. Edward’s mother decided to send him to live with his father in the Democratic Republic of Congo (DRC). “I hate Kiswahili and French, those languages remind me of the hard times I faced in Congo”. He was abducted by M23 rebels and he still wonders whether his father was one of them or an obliging victim too. He managed to escape and found his way back to Uganda under the protective wings of his mother. Together they made and sold papyrus mats and paper beads. The proceeds paid for their basic needs and he went back school only to drop out again after senior one. However, Edward was not a give up kind of man, on top of their crafts business, he got a job with MTNUganda (a telecommunication company) as a direct

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Reach Out Mbuya Annual Report 2014

In 2009, Edward enrolled at Uganda College of Commerce-Aduku for a Diploma in Business Studies-majoring in Accounting and Finance. His performance impressed his tutors that three out of the four semesters were paid for by the institution. Reach Out Mbuya then catered for his functional fees and accommodation. After completing school, he returned to ROM as an intern, after which, he decided to work as a volunteer which he felt was the only way he could give back to an organization that had given him so much. He was later taken on a staff and he worked with ROM until he left the organization after a motor accident “I have had two very big blows in my life, the death of my mother and the fatal motor accident I survived in 2013” Edward laments. “I went to the graduation grounds alone; my mother did not live to see me graduate. However, Edward always picks himself up. Today he is the Production Manager of Ntake Bakery; one of the leading bakeries in the city where he started off as a data entrant and a sales accountant. He attributes his fast growth to determination and hands-on training that he received in Reach Out. “Reach Out is responsible for the person I am now. They took care of my mother when she was sick even though she later passed on.They took me from a papyrus-mat maker, to school and look where I am now. I will forever be grateful. I am sure my mother smiles upon me too and all other children out there. Never let Circumstances Shape your future” I am still shaping mine too.’’

Highlights of Program Activities Highlights of program activities HIV counseling and testing  23,945 individuals accessed HIV Counseling and Testing (HCT); 1,915 (8.0%) HIV positive  1,599 key populations accessed HCT; 206 (19.6%) HIV positive  21,593 (26.8% males) individuals reached with prevention messages; 4,015 (19%) were MARPs Care and support  1,474 clients enrolled into care  6,726 clients received holistic care; 6,203 still active in care; 70% are female  437 (7.5%) of the active clients were children aged less than 15 years old  30,578 home visits made to 6,203 clients; 864 Clients were affected during the massive evictions of dwellers along the railway line  62,313 laboratory tests; 36% HIV test, 7% Malaria tests, 17.1% CD4 count & 2.5% Sputum for AFBs among other tests Elimination of Mother To Child Transmission of HIV  3,722 HIV positive women in reproductive age were screened for pregnancy; 219 (5.9%) were pregnant; 160 HIV positive mothers were started on option B+  232 HIV positive mothers delivered; all infants received NVP syrup  487 infants received an HIV DNA-PCR test and 21 infants had a positive result; 13 mothers joined eMTCT during PNC and 8 did not adhere to the cascade. ROM continues to show 0% MTCT among mothers adhering to the complete PMTCT cascade Anti-Retro Viral Therapy  5,447 clients (87.8%) on ART; 188 (3.1%) on second ART regimens  85% of clients with adherence > 88% Tuberculosis  893 presumptive TB cases identified and investigated for TB  220 clients newly diagnosed with TB and treated  Treatment success rate (TSR) at 87% Community support services  1,754 OVC supported through the school fees program, 1,101 (62.8%) in primary level, 484 (27.6%) in secondary school and 169 (9.6%) in tertiary institutions  2,171 OVCs participated in the peer-led psychosocial interventions  448 OVC households received food with 1,987 secondary beneficiaries  324 VSLA groups were sustained, 9,720 people benefited from VSLA; 6,610 (68%) were women, 40% are HIV positive Governance, Management and staffing 

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ROM welcomed new executive director; Dr. Betty Nsangi Kintu and bid farewell to Dr. Stella Alamo Talisuna former Executive Director ROM had a total of 165 staff during the period, 64% female, 35.1 % are clients ROM hosted 64 volunteers and 23 students for placement ROM received 4 awards; 1) Golden award for outstanding performance in logistics management of HIV commodities 2) Outstanding contribution to the people living with HIV (PLHIV) in Uganda from National forum of people living with HIV/AIDs Network in Uganda, 3) Best creative dance group during the Uganda youth annual national youth conference 4) Award for Hosting the Global health corps fellow

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nseling and Testing (HCT) tinued with its integrated approach to service delivery and HCT was of Medical Directorate

point into the existing programs. The HCT approaches included; facilit

The directorate (Moonlight continued to scale up HIV Counseling and Testing (HCT) ed, community HCT, corporate league and during com comprehensive medical services to HIV positive clients’ and social support to their families, with special attention given to the key populations. At Kasaala, Luweero, HIV/AIDS services are integrated into Primary health care (PHC).

ROM (PPP) continued with integrated approach n activities), Public-private partnership andits Mobile outreaches (T to service delivery and HCT was offered as an entry point into the existing programs. The HCT approaches included; facility-based, homebased, community (Moonlight HCT, corporate league and during community prevention activities), Public-private partnership (PPP) and Mobile outreaches (Table 1). Special focus was on key populations and couples. The 3.4% increase of individuals accessing HCT from the previous year was attributed to addition of two high volume health facilities (Good Samaritan maternity home and Kireka Health center) and scaling up of services to 10 key population hotspots. Of those who tested 1,915 (8.0%) had a positive result.

ocus was on key populations and couples. The 3.4% increase of ind

HCT from previous year was attributed to addition of two high volum HIV the PREVENTION

(Good Samaritan maternity home and Kireka Health center) and scalin The HIV prevention interventions focused on HIV counseling and testing (HCT), Positive health dignity and prevention , prevention of mother to child transmission (PMTCT), early infant diagnosis (EID), and safe male circumcision (SMC) which was done in collaboration with the Infectious Diseases Institute (IDI).

o 10 key population hotspots. Of those who tested 1,915 (8.0%) had a Figure 1: Numbers accessing HCT (2010-2014) Figure 1: Numbers accessing HCT (2010-2014)

30000 25000 20000

25% 20%

20%

15%

15%

15000

10%

10000 5000

8231

10825

10206

9% 22364

8% 23945

0

5% 0%

2010

2011

2012

Tested

2013

2014

%age HIV +

Positivity according to mode of HCT delivery, 2012-2014

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10%

Reach Out Mbuya Annual Report 2014

Table 1. Positivity according to mode of HCT delivery, 2010-2014) 2012

Approach

2013

2014

Tested

% HIV + Tested % HIV + 2012 2013 Approach Facility 4023 12% 6433 18% Tested 2012% HIV + Tested 2013 % HIV + ANC Approach 386 4% 188 6% Facility 4023 12%+ 6433 18%+ Tested % HIV Tested % HIV PNC* 2012 2013 58 17% ANC 386 4% 188 6% Facility 4023 12% 6433 18% Approach Mobile outreaches Tested % HIV + 4023 % HIV + 5% Tested 5485 5%Tested PNC* 58 17% ANC 3864%188 6% Facility HBHCT 1% 5793 4023325 12% 11% 6433 573 18% Mobile 40235%5485 5% PNC* outreaches 58 17% Public-private partnership ANC 455 4% 5% 1429 386325 4%11% 188 6716 6% HBHCT 573 1% Mobile outreaches 4023 5% 5485 5% Moonlight PNC* 315 10% 846 7% 58 17% 293 Public-private partnership 455 4% 6716 5% HBHCT 325 11% 573 1% Other outreaches Mobile outreaches 423 43% 5485 1737 5% 7% 5281 4023315 5%10% Moonlight 846 7% Public-private partnership 455 4% 6716 5% Immunization outreaches HBHCT 256 9% 328 1% 8% 956 325 11% 573 Other outreaches 423 43% 1737 7% Moonlight 315 10% 846 7% Totals Public-private partnership 10206 22364 455 4% 6716 5% 8238 Immunization outreaches 256 9% 328 8% Other outreaches 423 43% 1737 7% * There was no PNC aggregated data 315 Moonlight 10% 84622364 7% 644 Totals 10206 Immunization outreaches 256 9% 328 8% outreaches 423 by age, 43% 1204 *Other There was no PNC aggregated data HCT Table 2. Numbers accessing 2014 173722364 7% Totals 10206 Immunization outreaches No. tested 256 Positive 9%(%) 328 8% 107 *Age There was no PNC aggregated data

Table 2. Numbers accessing HCT by age, 2014 < 15 years 2,100 135 (6.4) Totals

10206 Positive (%) 22364 Age No. tested Table 2. Numbers accessing HCT by age,(8.1) 2014 15 – 49 years 21,192 1,718 * There was no PNC aggregated data < 15 years 2,100 135 (6.4) Age No. tested Positive ≥ 50 years 653 62 (9.5) (%) 15 – 49 years 21,192 1,718 (8.1) < 15 years 2,100 HCT by age, 1352014 (6.4) Table 2. Numbers accessing Total 23,945 1,915 (8.0%) ≥1550– years 653 62 (9.5) 1,718(%) (8.1) Age 49 years No.21,192 tested Positive Total 23,945 1,915 (8.0%) ≥ 15 50years years 653 accessing (9.5)2014